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Incidence of Post-traumatic Osteoarthritis in Olecranon Fractures: A Systematic Review
Jort P Wiersma, BS
1, Huub H de Klerk, BS
1, Simone Priester-Vink, Msc
2, Job N Doornberg, MD, PhD
3, Abhiram Bhashyam, MD
1; Michel Van den Bekerom, MD
4(1)Massachusetts General Hospital, Boston, MA, (2)OLVG, Amsterdam, Noord Holland, Netherlands, (3)Groningen University Medical Centre, Groningen, Groningen, Netherlands, (4)VU University Medical Center Amsterdam, Amsterdam, Netherlands
Background:
Olecranon fractures are common fractures of the elbow and may lead to symptomatic post-traumatic osteoarthritis (OA). The incidence and risk factors for ulnohumeral OA after an olecranon fracture remain uncertain. Therefore, this review aimed: 1) to determine the incidence rate of OA following isolated olecranon fractures; 2) to assess the role of instability and comminution in the development of OA, and 3) to assess the impact of OA on patient-reported outcome measures (PROMs).
Methods:
Multiple databases were searched for studies containing the terms "olecranon", "osteoarthritis", and "fracture". Studies were screened for predetermined inclusion and exclusion criteria, requiring a minimum follow-up of 24 months. Patient demographics, treatment, OA classifications, PROMs, complications, and reoperation rates were collected. The studies' methodological quality was assessed using the MINORS criteria. The Mayo classification was used to assess olecranon fractures for comminution and instability, categorizing them into three types: type 1 (non-displaced, stable), type 2 (displaced, stable), and type 3 (displaced, unstable). Each type is subdivided into A (non-comminuted) or B (comminuted). Due to a high degree of heterogeneity, pooling of the data was avoided; instead, results were summarized using ranges, medians, and interquartile ranges.
Results:
Eleven studies were included, comprising a total of 362 patients with a median follow-up of 41 months (Range: 27-240; IQR: 29-74). The MINORS scores for these studies ranged from poor to moderate. The median OA incidence rate across these studies was 19% (Range: 0%-35%; IQR: 3%-26%). The median OA incidence was 25% (Range: 0%-50%; IQR: 13%-38%) for Mayo type 1 fractures, 16% (Range: 0%-30%; IQR: 0%-25%) for type 2, and 50% (Range: 40%-100%; IQR: 45%-75%) for type 3. For non-comminuted fractures (type 2A), the median OA incidence was 16% (Range: 0%-28%; IQR: 0%-18%), while for comminuted fractures (type 2B), the median was 24% (Range: 0%-38%; IQR: 17%-30%). MEPS scores for patients with OA were reported in 3 studies with a median score of 93 (Range: 83-94). The median MEPS across all included studies was 92 (Range: 86-98; IQR: 90-96).
Conclusion:
This review shows a considerable rate of OA following isolated olecranon fractures. However, final PROMs ranged from good to excellent regardless of fracture type or the presence of OA. Given that all studies were of poor to moderate quality with significant heterogeneity, additional larger studies with longer follow-up times are needed to assess if comminution or instability affects the likelihood of ulnohumeral OA even after appropriate surgical treatment.
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